ArticleFrontiers in public health2026
Psychometric validation of the Spanish HLS-EU-Q16 in Ecuador: evidence for health literacy assessment and public health education.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Health literacy (HL) is a key determinant of individual and public health outcomes, as it influences people's ability to access, understand, and apply health information for informed decision-making. Although the European Health Literacy Survey Questionnaire (HLS-EU-Q16) has been validated in several countries, no psychometric validation had previously been conducted in Ecuador. Methods: This study evaluated the psychometric properties of the Spanish version of the HLS-EU-Q16 in a sample of 612 Ecuadorian adults from the three main regions of the country. Confirmatory factor analysis (CFA) was conducted to examine the factorial structure. Internal consistency was assessed using Cronbach's alpha and McDonald's omega, measurement invariance was tested across sex, age, and area of residence, and known-groups validity was evaluated through group comparisons. Results: The CFA supported a three-factor model consistent with the theoretical framework of healthcare, disease prevention, and health promotion (χ Discussion: These findings confirm that the Spanish HLS-EU-Q16 is a valid, reliable, and invariant instrument for assessing health literacy in Ecuadorian adults. The availability of this tool provides a solid foundation for evidence-based health education, targeted interventions, and public health policies aimed at promoting equity and strengthening health literacy in Ecuador and Latin America.
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